Intrauterine contraceptive devices and inserters therefor

ABSTRACT

The present invention relates to intrauterine contraceptive devices in the general shape of a &#39;&#39;&#39;&#39;7&#39;&#39;&#39;&#39; having a transverse arm and a longitudinal arm dependent substantially from an end thereof; method of contraception by insertion of such a device into the uterus; instruments and methods for the insertion of intrauterine contraceptive devices into the uterus without employment of forces propelling said devices from the instruments in the direction of the uterine fundus.

United States met [191 Abrarnson Dec. 11, 1973 INTRAUTERINECONTRACEPTIVE [56] References Cited DEVHCES AND INSERTERS THEREFORUNITED STATES PATENTS [75] Inventor: Harvey ,1. Abramson, New York,2,047,295 7/1936 Sipos 85/83 N.Y. 1 3,467,088 9/1969 Robinson 128/130 73A G. 1 l 1 sslgnee D Sear e & C0 chlcago Primary Examiner-Richard A.Gaudet [22] Filed: June 11, 1971 Assistant Examiner-G. F. Dunne [21]Appl- No 152,231 Attorney-John M. Brown et a1.

Related U.S. Application Data [57] ABSTRACT [63! gg of Ser'v June Thepresent invention relates to intrauterine contra- ,abandoned.

ceptive devices 11'] the general shape of a 7 having a transverse armand a longitudinal arm dependent sub- [30] Foreign 'Yf Pnomy Datastantially from an end thereof; method of contracep- June 15, 1970Philippines 11535 tion yinsertion of Such a device into the uterus; i

struments and methods for the insertion of intrauter- [52] U.S. Cl.128/130 ine contraceptive devices into the uterus without [51] 1111. C1.A6 5/46 p y of forces propelling Said devices from the [58] Field ofSearch 128/127, 128, 129; instruments in the direction of the uterinefundus.

23 Claims, 34 Drawing Figures PATENTEUHEI: 1 1 ma 'SHEET 30F 8 Q9 EH11 PHHHWPIH-IIHHHHHH HHHH 1 mm, yy fl Q3 Q2 T m If T 3 i 92 Ta mm R Q 4 i|.H uHhHl HU PIUHHHHHHHH Hu A F FUHHH IHHH mm, 91 MQNQ L w T's T 9o T EPATENTED DEC 1 1 SHEET 5 UP 8 1 INTRAUTERINE CONTRACEPTIVE DEVICES ANDINSERTERS THEREFOR This application is a continuation-in-part of mycopending US. application Ser. No. 836,371 filed June 25, I969, and nowabandonedand claims the priority of an application Ser. No. 1 I535 filedin the Philippines on June 15, I970.

The present invention relates to intrauterine contraceptive devices; tomethods of contraception employing said devices; to instruments for theinsertion of an intrauterine contraceptive device into the uterus; tocombinations, suitable for sterile packaging, of an intrauterinecontraceptive device and an instrument for the insertion thereof intothe uterus;.and to methods of inserting an intrauterine contraceptivedevice into the uterus. I

It is known in the prior art that the presence of a foreign object inthe uterus discourages conception. This phenomenon has been medicallyexploited for the intentional prevention of conception by insertion intothe uterus of so-called intrauterine contraceptive devices, such as thewell-known Lippes loop, commonly comprising a ring, spiral, or zigzagofa physiologically inert material, commonly plastic.

The employment of these devices for the purposes of contraception hasheretobefore been subject to a number of disadvantages. First, thedevices of the prior art have generally been of such dimensions as tendin situ to distort the uterus in the dorso-ventral and lateraldirections, thereby causing discomfort, bleeding, and muscular spasmstending to eject the contraceptive device from the uterus. Further, thestructure of such devices has heretobefore not always been such as todiscourage involuntary ejection thereof, from the uterus. Also, thedimensions assumed by the prior art devices when in a form suitable forinsertion into the uterus either prevent or make difficult theirinsertion into a nulliparous cervical canal. Dilatation is oftennecessitated and requires general anesthesia. Finally, the insertion ofsuch intrauterine devices has heretobefore been accompanied by asignificant danger of puncturing the uterine wall because insertioninvolves pushing a device from suitable carrier instrument into theuterus in the direction of the uterine fundus. By inadvertence ormiscalculation, the physician inserting the device may unknowinglypush'th'e device into or through the uterine wall, thereby giving riseto serious medical complications.

According to the present invention, intrauterine devices of suchdorso-ventral and transverse dimensions as minimize rejection reactionshave been devised. The novel structure of said devices, further,discourages inadvertent or involuntary discharge of the device from theuterus. Also, instruments for the insertion of intrauterinecontraceptive devices have been discovered, which instruments do notrequire pushing forces in the direction of the uterine fundus to depositthe devices in the uterus. The chances of inadvertent puncturing of theuterine wall are thereby minimized. Still further, combinations of theseinstruments with intrauterine devices, including not only devices knownin the prior art but also the novel devices taught herein, have beendiscovered. These combinations particularly lend themselves to sterilepackaging as an integral unit for immediate use by an attendingphysician and disposal after use. Finally, methods of preventingconception employing novel intrauterine contraceptive devices aredisclosed herein, as are novel methods of inserting intrauterine devicesinto the uterus.

A better understanding of the present invention and of its manyadvantages will be had by referring to the following drawings, in whichFIG. I is a perspective view of an intrauterine device and an instrumentfor the insertion of said device into the uterus;

FIG. 2 is a sectional view through the intrauterine device of FIG. 1along the line 2-2 of FIG. 1;

FIG. 3 is anenlarged side view of the instrument of FIG. 1, partially insection, showing the intrauterine device of FIG. I folded in anteriorportions thereof;

FIG. 4 is anenlarged end view of the instrument of FIGS. I .and 3,showing an intrauterine device present folded therein; 1

FIG. 5 is a front view, partly in section, showing the instrument ofFIG. 1 inserted into the uterus and the contraceptive device of FIG. 1partially emergent therefrom;

FIG. 6 is the same view as FIG. 5 showing the further emergence of thecontraceptive device from the instrument for the insertionthereof;

FIG. 7 is the same view as in FIGS. 5 and 6 showing the intrauterinedevice in position in the uterus after withdrawal of the instrument forinsertion;

FIG. 8 is a side view of another embodiment of an instrument for theinsertion of an intrauterine device into the uterus, showing anintrauterine device in combination therewith;

FIG. 9 is a plan view of the instrument and device of FIG. 8,

FIG. 10 is a sectional view of this same instrument taken along line10-10 of FIG. 8;

FIG. 11 is a further sectional view of this instrument and device takenalong line 11-11 of FIG. 8;

FIG. 12 is still another sectional view of this instrument taken alongline 12I2 of FIG. 8;

FIG. 13 is a side view of the instrument and device of FIGS. 8 12showing the manner in which the instrument is readied for insertion intothe uterus for introduction of an intrauterine device thereinto;

FIG. 14 is a side view of the same instrument, showing the instrument insitu in the uterus; I

FIG. 15 is a side view like that in FIG. 14, showing a later stage inthe insertion of an intrauterine device into the uterus;

FIG. I6 is the same view as in FIGS. 14 and 15 showing a still laterstage in the insertion process, and particularly showing an intrauterinedevice present in the uterus and withdrawal of the inserting instrumenttherefrom;

FIG. 17 is a front view, in section, taken along line l7-I7 of FIG. 16showing an intrauterine device present within the uterus after insertionthereof is complete;

FIG. 18 is a scale drawing of an embodiment of the intrauterine deviceof the present invention;

FIG. 19 is an enlarged plan view, in section, of the device of FIG. 13taken along line -19919 of FIG. I3;

FIG. 20 is an enlarged plan view, in section, taken along line 20-20 ofFIG. 15;

FIG. 21 is a perspective view of a preferred embodiment of theintrauterine device of this invention comprising a transverse arm and alongitudinal arm;

FIG. 22 is a sectional view throughone section of the transverse arm ofthe intrauterine devices of FIGS. 21 and 28 along the line 22-22 ofFIGS. 21 and 28;

FIG. 23 is a sectional view through another section of the transversearm of the intrauterine device of FIG. 21 along the line 23-23;

FIG. 24 is a sectional view through the midsection of the longitudinalarm of the intrauterine devices of FIGS. 21 and 28 along the line 24-24;

FIG. 25 is a sectional view through an end section of the longitudinalarm of the intrauterine device of FIG. 21 along the line 25-25;

FIG. 26 is an enlarged perspective view of the longitudinal arm of apreferred alternate embodiment of FIG. 21 having a copper wire wrappedaround the arm;

FIG. 27 is a sectional view through a section of the intrauterine deviceof FIG. 26 along the line 27-27;

FIG. 28 is a perspective view of an alternate embodiment of theintrauterine device of this invention comprising a transverse arm and alongitudinal arm with the transverse arm terminating in a substantiallyhemispherical nub;

FIG. 29 is a sectional view through one section of the transverse andlongitudinal arms of the intrauterine device of FIG. 28 along the line29-29 of FIG. 28;

FIG. 30 is a perspective view of an alternate embodiment of theintrauterine device of FIG. 28, as viewed from the line 30-30 of FIG.28, having a copper wire wrapped around-the longitudinal arm;

FIG. 31 is a sectional view of the aperture for attachment of filamentmeans to the device of FIG. 28 along the line 31-31 of FIG. 28;

FIG. 32 is a partially sectional view of the intrauterine device of FIG.28 loaded in a folded configuration within an inserter barrel;

FIG. 33 is a perspective view of the distal end of Iongitudinal arm 120as viewed from the back side of FIG. 28'.

FIG. 34 is a partially sectional view of the intrauterine device of FIG.28 loaded in an alternate configuration with the transverse arm locatedoutside of the inserter barrel.

Referring to FIGS. 1, 18, 21, 26 and 28 of the accompanying drawings, itwill be seen that the novel intrauterine contraceptive devices of thepresent invention have the general shape of the numeral 7, and comprisetransverse arm 110 and longitudinal arm 120 dependent therefromsubstantially at one end thereof.

The transverse and longitudinal arms of the device are proportioned tobe comfortably accommodated within the uterine cavity. Transverse arm110 suitably has an overall length of from 20 to 38 millimeters, whereaslongitudinal arm 120 is of such dimensions that the overall length ofthe device is from 28 to 40 millimeters. The preferred dimensions dependon the size of the uterus which is primarily dependent on the degree ofparity. The multiparous, primiparous and nulliparous uteri are generallydecreasing in size and may conveniently permit the use ofcorrespondingly differently sized intrauterine devices. The transverseand longitudinal arms of the devices are coplanar and suitably have athickness of from about I millimeter to about 3 millimeters at thethickest part.

As shown in FIGS. 1 and 18, transverse arm 110 can optionally have aflexure 130 substantially at the midpoint therein, flexed arm 110 beingdownwardly concave in the direction of longitudinal arm 120. If a lineis drawn connecting the end points of transverse arm 110 and aperpendicular to this connecting line is dropped from the mid-pointthereof, the terminal portion of longitudinal arm 120 suitably lies onthe perpendicular. Since longitudinal arm 120 is dependent from an endof arm 110, longitudinal arm 120 is generally arcuate.

In the devices of FIGS. 21 and 28, transverse arm 110 has the shape ofan arc and longitudinal arm 120 has an arched upper portion 132 and agenerally straight lower portion 134. If the line of the longitudinalarm 120 is extended upwardly, it will intersect the transverse' arm 110at the uppermost portion of the arcuate transverse arm 110. The archedportion of transverse arm 110 is generally a substantially circular arcof between about 2590, preferably between about 40-60, and the archedupper portion 132 of longitudinal arm 120 is generally a substantiallycircular arc of between about 45-I 20, preferably between about -l20.Such construction enables the arms to be folded with minimum stress,i.e., the transverse arm and the longitudinal arm can be folded in sucha manner that the folded transverse diameter will not be greater thanthe two transverse arms and it will retain its shape.

The devices of FIGS. 18, 21 and 28 are suitably made in whole or in partofa rigid but flexible physiologically inert material, commonly aplastic such as polyethylene, polypropylene, nylon, a poly (organosiloxane) such as that sold under the trademark Silastic, Dacron or thelike. Polypropylene is particularly preferred. Barium sulfate or otherbarium compounds may be used with the above materials as an aid indetecting the presence of the device in the uterus. The device can alsobe constructed in whole or in part of a metal such as silver, gold,platinum or preferably copper or zinc.

Because of the devices small size and high retentive properties, thedevice is an excellent carrier for more active fertility regulatingmaterials, especially elemental copper or zinc or both. For example, asshown in FIGS. 26 and 30, zinc wire, copper wire, or copper tubing 136can be wound around the arms. Other means of applying the metals arevacuum metallizi'ng', partial impregnation of metallic granules, and theuse of one or more shaped forms such as a chain or wire dependent froman arm.

Although the intrauterine device of the present invention can havecylindrical arms as shown in FIGS. 1 and 18, the arms of the device canalso be in the shape of semi-cylinders as shown in FIGS. 22, 24 and 29.These meet at a cylindrical apex 144, as shown in FIGS. 23, or at asubstantially hemispherical nub 151, as shown in FIG. 28, the arms beingdesigned in such a manner that when the device is folded, the flatportions come in contact and the folded device takes up a smaller amountof space, as shown in FIGS. 21-24. The limited amount of space taken upby the device in its folded configuration is particularly desirablesince the device can then be inserted easily into nulliparous orprimiparous patients with no dilation of the cervical canal beingrequired.

In the device of FIG. 28, transverse arm terminates in agenerallyrounded protuberance 151, preferably a substantiallyhemispherical nub, and longitudinal arm is dependent therefrom. Thisnovel configuration provides a gently rounded surface at the anteriorend of the inserter barrel when the intrauterine device is loaded in itsfolded configuration within the barrel of the inserter as shown in FIG.32. That rounded surface facilitates insertion of the device into thecervical canal and minimizes any irritation whichmight occur. Typically,nub 151 is of sufficient diameter to cover'the edges of the-insertiontube when the device is loaded in its folded configuration as shown inFIG. 32. Furthermore, the rounded nub allows the loaded inserterinstrument to be used as a uterine sounding device.

Notch 152 on nub 151, as shown in FIGS. 29 and 30, and groove 154, asshown in FIGS. 31 and 33, provide space for the placement of filamentmeans attached to the distal end of longitudinal arm 120 when the deviceof FIG. 28 is located in its folded configuration within the barrel ofan insertion instrument as shown in FIG. 32. The device of FIG. 28 maybe loaded in an alternate folded configuration within the inserter asshown in FIG. '34 wherein transverse arm 110 is located outside of theinserter barrel and longitudinal arm 120 is singularly located withinthe inserter barrel.

As shown in FIG. 30, notches 153 provide locations for embedment of theends of the copper wire 136 which is optionally wrapped on longitudinalarm 120.

The device of FIG. 1, shown in section in FIG. 2, comprises resilientcore 150 made of material such as spring wire (e.g. piano wire) havingcoating 160 thereover. Coating 160 is suitably of a physiologicallyinert substance such as those mentioned just above. Additionalresilience and ease of flexion is achieved in the alternate device ofFIG. 1 by forming coils 170 at flexure 130 of transverse arm 120 and atthe point at which longitudinal arm 120 is attached thereto.

Physiologically inert filament 180 is suitably attached to terminalportions 140 of the devices of FIGS. 1 and 18 to facilitate theirremoval from the uterus and, as will be seen, in some cases to aid intheir insertion into the uterine cavity. As shown in FIGS. 21, 2S and28, the filament can be emplaced in aperture 148.

FIG. I further shown tubular instrument 190 comprising barrel 200 foraccommodation of an intrauterine device. Stop means 21 are located onthe exterior portions of instrument 190 at a distance from anterior end22 thereof corresponding with 'a depth to which it is desired to insertbarrel into the-uterinecavity. Means 23 are provided at the posteriorend of instrument 190 to facilitate grasping and manipulation of theinstrument.

FIGS. 3 and 4 show the intrauterine device of FIG. 1 and FIG. 21 mountedwithin barrel 200 of instrument 190 of FIG. 1. As is best seen from FIG.3, transverse arm 110 of the device is bent downward from the point ofattachment to longitudinal arm 120 to lie along an axis substantiallyparallel to that of the longitudinal arm, which position also requiressome straightening of arm 110 at flexure 130 in the case of theintrauterine device of FIG. I. Distortion of the device in this manneris possible because of the inherent resiliency of the material of core150 as well as structural features such as coils 170. The device isloaded within instrument 190 such that terminal portion 140 oflongitudinal arm 120 is farthest from anterior orifice 22. Filament 180extends from terminal portion 140 out of orifice 22.

As is best seen from FIG. 4, barrel 200 is suitably elliptic in shape,whereby the folded device is constrained within a plane fixed withrespect to inserting instrument 190.

FIGS. 5 7 show the insertion of a contraceptive intrauterine deviceaccording to the present invention into the uterus employing instrument190 of FIG. 1. In particular, FIG. 5 shows instrument 190 in situ withbarrel 200 inserted into uterus 24 until stop means 21 abut exteriorcervical os 25. By pulling on filament 180 downwards in the direction ofthe arrow, said filament extending from anterior orifice 22 backwardsalong barrel 200 into the vagina 26, the contraceptive device lodged inbarrel 200 is pulled therefrom until emergence from anterior orifice 22of coil 170 at the junction-of transverse arm llllyand longitudinal arm120. The arcuate shape of longitudinal arm and theresilience of foldedtransverse arm 110tend to embed the juncture (coil 170) firmly into theuterine wall at point 27. Because of this embedment at point 27, furtherpulling on filament 180 exerts a downward force on the rim of barrel 200at anterior orifice 22 tending toretract barrel 200 from the uterus.

This stage is shown in FIG. 6 of the accompanying drawings in whichbarrel 200 is shown sufficiently retracted from uterus 24, and from theintrauterine device therein, to permit escape of entire transverse arm110. Lateral pressure exerted by the resilient material of the devicearound flexure tends to embed the free end of transverse arm 110 intothe uterine wall at point 28.

Finally, FIG. 7 shows the intrauterine device in situ in the uterusafter complete withdrawal of the inserting instrument. It will beevident from FIG. 7 that the device is firmly anchored in the uterinecavity at points 27 and 28 already discussed, as well as at point 29 atwhich terminal portion of longitudinal arm, 120 makes contact with theuterine wall. This three point contact is highly effective in preventinginadvertent dislodgement or expulsion of the device from the uterus.

As will further be seen from FIGS. 5 7, it is evident that deposition ofthe intrauterine device within uterine cavity 24' has been accomplished.without pushing forces tending to move the device in the direction ofuterine fundus 30. Once the device has been sufficiently expelled frombarrel 200 for one end of transverse arm 110 to make contact with theuterine wall (cf. point 27 of FIG. 5), further tension on filamentrepels barrel 200 from uterus24, rather'than propelling the intrauterinedevice from the barrel. In this manner, the danger of puncturing uterinefundus 30 due to the propulsion of an intrauterine device into theuterus by pushing forces is greatly reduced.

FIGS. 8 12, in which the reference numbers respectively refer to thesame structural features, show a preferred embodiment ofan instrumentfor the insertion of an intrauterine contraceptive device into theuterus.

The device shown in these Figures comprises first barrel 31 havingexterior stop means 32 positioned therealong at a distance from anteriororifice 33 of barrel 31 corresponding to a desired depth to which barrel31 is to be inserted into the uterus.

The device shown in these figures similarly has second barrel 34adjacent said first barrel and having a slot or keyway 35 (best seen inFIGS. 11 and 12) therein. Bifurcate piston 36 slides within barrels 31and 34, and has first fork 37 in barrel 31- and second fork 38 in barrel34. Second fork 38 of piston 36 is provided with stop means 39 externalto barrel34 movable within keyway 35 therein, as is best seen from FIG.10.

First and second barrels 31 and 34 suitably have common grip means 40,advantageously fashioned to engage with the index and middle finger ofthe hand. Similarly, piston 36 is provided with handle means 41 which,when actuated (for example by thumb pressure), cause simultaneousmovement of piston forks 37 and 38 within barrels 31 and 34respectively.

The instrument of FIGS. 8 12 is there shown in combination with anintrauterine device like that of FIG. 18 comprising transverse arm 110,longitudinal arm I20, and filament 180 attached thereto. Theintrauterine device is suitably loaded into the instrument of FIGS. 8 12by insertion into transverse slot 42 in barrel 31 posterior to stopmeans 32. Longitudinal arm I20 lies axially within barrel 31, which isadvantageously further slotted in an axial direction. Suitably, one ortwo axial slots are provided to accommodate a transverse arm or arms ofan intrauterine device. These axial slots and their function can best beseen and understood by referring to FIGS. 13, 14, and 19, and to FIGS.and 20.

In particular, FIGS. 13, 14, and 19 show an intrauterine contraceptivedevice positioned within barrel 31 of the instrument shown in FIGS. 812. Transverse arm 110 of the device extends from barrel 31 in onedirection through axial slot 43 and, in the other direction, throughsomewhat longer axial slot 44. Longitudinal arm 120 of the device iswithin barrel 31 and extends axially therealong. This start" or restposition of the intrauterine device is shown in FIG. 19 in dashed linesand represents the preferred position of the intrauterine device in theinserting instrument at the time of sterile packaging. In this position,no forces are exerted on the flexible intrauterine device which mighttend to distort of malform it.

When the physician intends to insert an intrauterine device using thecombination shown in FIG. 13, he opens the sterile package in which thedevice and inserting instrument are packed. As shown in FIGS. 13 and 14,barrels 31 and 34 are conveniently grasped with one hand and movablepiston 36 with the other. The device is then inserted into uterus 24, asin FIG. 14, until stop 32 on barrel 31 makes contact with exteriorcervical os 25. Then, as shown in FIG. 15, pressure is applied to handlemeans 41 against counterpressure applied to grip 40 to advance piston 36forwards in barrels 34 and 31 until stop means 39, external to barrel 34and traveling in the keyway therein, also make contact with externalcervical os 25.

As is best seen from FIG. 19, advancement of piston fork 37 withinbarrel 31 causes the intrauterine device therein to fold itself withinbarrel 31 into the position shown in solid lines in FIG. 19. Todistinguish the rest position and the folded position in FIG. 19, thereference numerals referring to the folded position have been primed.

Thus, upward pressure on piston 37 of FIG. 19 causes arm 110 of theintrauterine device to pivot counterclockwise around a pivot point atthe upper end 45 of shorter axial slot 43. As further upward pressure isexerted on the device by piston 37, transverse arm 110 ascends, enterslonger axial slot 44 in barrel 31, and folds back on longitudinal arm120 until the arms assume the positions 110' and 120' shown in solidlines in FIG. 19. The folding of the device within barrel 31 also causessome advancement of the device within the barrel, e.g. such thatterminal portion 140 moves to a new position 140.

When stop 39 external to barrel 34 contacts exterior cervical 0s 25, asshown in FIG. 15, because of upward pressure on piston fork 38, pistonfork 37 will have accomplished the folding of the intrauterine devicewithin barrel 31 anc caused advancement of the device substantially toanterior orifice 33 of barrel 31, as shown in FIG. 15 and, particularly,in FIG. 20. At this time, the device is in position in the uterus, butis still sheathed within barrel 31. In the region of orifice 33,interior 31 of barrel 31 is preferably elliptic to maintain the devicein a fixed plane with respect to the instrument (cf. FIG. 12). I

As shown in FIG. 16, further pressure on handle means 41 cannot causefurther forward movement of piston 36 because of the impedance of theforward movement of piston fork 38 by contact of stop means 39 thereonwith exterior cervical os 25. Rather, the instrument, comprising barrels34 and 31, will tends to retract from the uterus in the direction of thearrow shown in FIG. 16, permitting the escape of the folded intrauterinedevice from anterior orifice 33. Piston fork 37 within barrel 31 retainsa fixed position relative to the uterus during this stage. It is theretrograde movement of barrel 31 downwards along piston fork 37 whichcauses unsheathing of the device within the uterus. The instrument iswithdrawn from around the intrauterine device when the device is in situin the uterus. There is no propulsion of the device from the instrumentby any pushing forces in the direction of uterine fundus 30. Properplanarity of the device with respect to the uterus is assured byelliptic interior 31' of barrel 31 and by the proper orientation ofbarrel 31 (and the instrument) to the uterine cavity.

FIG. 17 shows the device in situ in uterus 24 after insertion. As inFIG. 7, lateral and longitudinal arms and of the device make athree-point contact with the uterine wall at points 27, 28, 29,imparting particular stability to the device against accidentaldislodgement from the uterus.

It is to be understood that the instrument shown in FIGS. 8 12 need notbe used in conjunction with novel 7"-shaped intrauterinecontraceptivedevices particularly shown in the drawings and described in thisspecification. Rather, a device of a shape known in the prior art, suchas a zig-zag or vermiform device, may be loaded within barrel 31 of theinstrument prior to sterilization and packaging. Pre-packaging of adevice of such a shape, however, entails the risk that the device willbecome distorted while constrained within the barrel 31 of theinstrument, especially on long storage.

The instrument shown in these Figures can, however, also be employedwith other intrauterine devices which are packed in combination with theinstrument in an unstrained state. For example, thus, the 7"-shapeddevice of the present invention can be replaced with a T-shaped device,in which case it is suitable to make axial slots 43 and 44 in barrel 31of the instrument (cf. FIG. 19) of substantially equal length. Pressureon piston 36 causes fork 37 thereof to fold such a T-shaped device intobarrel 31 in the shape of an arrow, with the arms of the T folded backalong the longitudinal arm.

Still further, a contraceptive device in the shape of an inverted L canbe combined in an unstrained condition with the instrument of FIGS. 812. For folding such a device, the transverse arm of the L may extendfrom a single axial slot in barrel 3], or an axial slot may be dispensedwith altogether, in which case the transverse arm merely extends fromtransverse slit 42 in barrel 31.

The material from which the instruments contemplated according to thepresent invention can be fashioned is not critical. However, the use ofplastics is particularly convenient because the devices can be cheaplymanufactured and then disposed of after use. The manufacture of thebarrel from transparent or semi-transparent plastic materials permitsthe physician to observe the proper functioning of the device.

Although illustrative embodiments of the present invention have beendescribed herein with reference to the accompanying drawings, it is tobe understood that the invention is not limited to those preciseembodiments and that various changes and modifications may be effectedtherein by one skilled in the art without departing from the scope orspirit of this invention.

What is claimed is:

1. An intrauterine device consisting essentially of two arms formed ofphysiologically inert material and adapted to be placed in a uterus, afirst arcuate transverse arm and a second arcuate substantiallylongitudinal arm coplanar with said first arm and substantiallydependent from one end thereof, said first transverse arm bendingconcavely downwardly toward said second arm and said second arm bendingconcavely downwardly from said first arm the major portion of saidsecond arm extending generally along a line through the upper most pointof said first arm.

2. An intrauterine device as in claim 1 wherein said first and secondarms are formed from a continuous length of spring wire having aphysiologically inert coating thereon.

3. An intrauterine device as in claim 2 wherein the physiologicaly inertcoating is polypropylene.

4. An intrauterine device as in claim 2 wherein the outside surfacefurther contains copper.

5. An intrauterine device as in claim 4, wherein a copper wire is woundaround at least one of the arms.

6. An intrauterine device as in claim 1 in which the transverse arm hasa downwardly concave flexure substantially in the midpoint thereof.

7. An intrauterine device as in claim 1 in which said transverse armterminates in a generally rounded protuberance.

8. An intrauterine device as in claim 7 in which the outside surfacecontains copper.

9. An intrauterine device as in claim 8 in which at least one of saidarms is wrapped with copper wire.

l0. An intrauterine device as in claim 8 in which at least one of saidarms is plated with metallic copper.

11. An intrauterine device as in claim l in which said transverse armhas a portion thereof in the shape of a substantially circular arc andsaid longitudinal arm has an upper portion thereof in the shape of asubstantially circular arc and a lower portion thereof which issubstantially straight.

12. An intrauterine device as in claim 11 in which said transverse armis between about and 38 millimeters in length and the overall length ofsaid device is between about 28 and 40 millimeters, said arms having athickness of between about 1 and 3 millimeters at their thickest part.

13. An intrauterine device as in claim 12 in which said are of saidtransverse arm is between about 25-90 and said are of said 'upperportion of said longitudinal arm is between about 45120.

14. An intrauterine device as in-claim 1 in which the outside surfacecontains copper.

15. An instrument for the insertion of an intrauterine device into theuterus, said instrument comprising first barrel means for accommodationof said intrauterine device, said first barrel means having first stopmeans external to said barrel means in the anterior portion thereof at adistance from the anterior end of said first barrel means correspondingwith a desired depth of insertion of said first barrel means into theuterustsecond barrel means adjacent said first barrel means andextending to said first stop means, said second barrel means having akeyway therein; and bifurcate piston means in said first and secondbarrel means, said piston means having second stop means at the anteriorend thereof, said second stop means being external to said second barrelmeans and traveling in said keyway therein.

16. An instrument as in claim 15 wherein said first barrel means aretransversely slotted posterior to said first stop means foraccommodation of an intrauterine device partially within and partiallywithout said first barrel means. I

l7. An instrument as in claim 15 wherein said first barrel means areaxially slotted posterior to said first stop means for accommodation ofan intrauterine device partially within and partially without said firstbarrel means.

18. An instrument as in claim 15 wherein at least that portion of saidfirst barrel means forward of said first stop means has an ellipticcross-section.

19. In combination suitable for sterile packaging, an instrument asdefined in claim 15 and an intrauterine device in said first barrelmeans thereof.

20. A combination as in claim 18 wherein said intrauterine devicecomprises a first transverse arm having a downwardly concave flexuresubstantially in the midpoint thereof and a second arcuate arm, coplanarwith said first arm and substantially dependent from one end thereof.

21. A combination as in claim 20 wherein said device is folded withinsaid first barrel means.

22. In combination suitable for sterile packaging, an instrument asdefined in claim 16 and an intrauterine device in said first barrelmeans thereof, said device comprising a transverse arm and alongitudinal arm dependent therefrom, said dependent arm lying axiallywithin said first barrel mean and said transverse arm extendingoutwardly from transversely slotted portions of said first barrel means.

23. In combination suitable for sterile packaging, an instrument asdefined in claim 17 and an intrauterine device in said first barrelmeans thereof, said device comprising a first transverse arm having adownwardly concave flexure substantially in the midpoint thereof and asecond arcuate arm, coplanar with said first arm and substantiallydependent from one end thereof, said second arcuate arm being positionedaxially within said first barrel means and said first transverse armextending outwardly from axially slotted portions of said first

1. An intrauterine device consisting essentially of two arms formed ofphysiologically inert material and adapted to be placed in a uterus, afirst arcuate transverse arm and a second arcuate substantiallylongitudinal arm coplanar with said first arm and substantiallydependent from one end thereof, said first transverse arm bendingconcavely downwardly toward said second arm and said second arm bendingconcavely downwardly from said first arm the major portion of saidsecond arm extending generally along a line through the upper most pointof said first arm.
 2. An intrauterine device as in claim 1 wherein saidfirst and second arms are formed from a continuous length of spring wirehaving a physiologically inert coating thereon.
 3. An intrauterinedevice as in claim 2 wherein the physiologicaly inert coating ispolypropylene.
 4. An intrauterine device as in claim 2 wherein theoutside surface further contains copper.
 5. An intrauterine device as inclaim 4, wherein a copper wire is wound around at least one of the arms.6. An intrauterine device as in claim 1 in which the transverse arm hasa downwardly concave flexure substantially in the midpoint thereof. 7.An intrauterine device as in claim 1 in which said transverse armterminates in a generally rounded protuberance.
 8. An intrauterinedevice as in claim 7 in which the outside surface contains copper.
 9. Anintrauterine device as in claim 8 in which at least one of said arms iswrapped with copper wire.
 10. An intrauterine device as in claim 8 inwhich at least one of said arms is plated with metallic copper.
 11. Anintrauterine device as in claim 1 in which said transverse arm has aportion thereof in the shape of a substantially circular arc and saidlongitudinal arm has an upper portion thereof in the shape of asubstantially circular arc and a lower portion thereof which issubstantially straight.
 12. An intrauterine device as in claim 11 inwhich said transverse arm is between about 20 and 38 millimeters inlength and the overall length of said device is between about 28 and 40millimeters, said arms having a thickness of between about 1 and 3millimeters at their thickest part.
 13. An intRauterine device as inclaim 12 in which said arc of said transverse arm is between about25-90* and said arc of said upper portion of said longitudinal arm isbetween about 45-120*.
 14. An intrauterine device as in claim 1 in whichthe outside surface contains copper.
 15. An instrument for the insertionof an intrauterine device into the uterus, said instrument comprisingfirst barrel means for accommodation of said intrauterine device, saidfirst barrel means having first stop means external to said barrel meansin the anterior portion thereof at a distance from the anterior end ofsaid first barrel means corresponding with a desired depth of insertionof said first barrel means into the uterus; second barrel means adjacentsaid first barrel means and extending to said first stop means, saidsecond barrel means having a keyway therein; and bifurcate piston meansin said first and second barrel means, said piston means having secondstop means at the anterior end thereof, said second stop means beingexternal to said second barrel means and traveling in said keywaytherein.
 16. An instrument as in claim 15 wherein said first barrelmeans are transversely slotted posterior to said first stop means foraccommodation of an intrauterine device partially within and partiallywithout said first barrel means.
 17. An instrument as in claim 15wherein said first barrel means are axially slotted posterior to saidfirst stop means for accommodation of an intrauterine device partiallywithin and partially without said first barrel means.
 18. An instrumentas in claim 15 wherein at least that portion of said first barrel meansforward of said first stop means has an elliptic cross-section.
 19. Incombination suitable for sterile packaging, an instrument as defined inclaim 15 and an intrauterine device in said first barrel means thereof.20. A combination as in claim 18 wherein said intrauterine devicecomprises a first transverse arm having a downwardly concave flexuresubstantially in the midpoint thereof and a second arcuate arm, coplanarwith said first arm and substantially dependent from one end thereof.21. A combination as in claim 20 wherein said device is folded withinsaid first barrel means.
 22. In combination suitable for sterilepackaging, an instrument as defined in claim 16 and an intrauterinedevice in said first barrel means thereof, said device comprising atransverse arm and a longitudinal arm dependent therefrom, saiddependent arm lying axially within said first barrel mean and saidtransverse arm extending outwardly from transversely slotted portions ofsaid first barrel means.
 23. In combination suitable for sterilepackaging, an instrument as defined in claim 17 and an intrauterinedevice in said first barrel means thereof, said device comprising afirst transverse arm having a downwardly concave flexure substantiallyin the midpoint thereof and a second arcuate arm, coplanar with saidfirst arm and substantially dependent from one end thereof, said secondarcuate arm being positioned axially within said first barrel means andsaid first transverse arm extending outwardly from axially slottedportions of said first barrel means.